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					                                                                                          MO HealthNet
                                                                Specialized Medical Equipment & Supplies
                                                                                               10-01-09


                                  MO HEALTHNET

SPECIALIZED MEDICAL EQUIPMENT AND SUPPLIES

Specialized Medical Equipment & Supplies Guidelines
Following are guidelines for accessing medical equipment and supplies through various MO
HealthNet programs.


•   State Plan Medicaid/ MO HealthNet Services must always be accessed when they can meet a
    service need before waiver services are accessed. For example, if a needed item can be
    obtained through the Medicaid Durable Medical Equipment (DME) Program, it should be
    obtained through that program and should not be funded through the waiver service,
    specialized medical equipment and supplies. If the DME program will not cover an item but
    the item meets the definition of specialized medical equipment and supplies, it may be
    funded with this service.


•   For individuals under the age of 21, many equipment and supply needs can be obtained
    through the Durable Medical Equipment (DME) Program due to federal EPSDT mandates.
    Missouri refers to EPSDT services as Healthy Children and Youth (HCY). Fewer items are
    covered by the DME program for persons who are 21 years of age or older.


•   Equipment and supply requests might also be covered through the MO HealthNet exception
    process. In order for MO HealthNet to consider approving an exception request, one or more
    of the following conditions must be documented with the request (see exception process):
       1.) The item or service is required to sustain the recipient’s life;
       2.) The item or service would substantially improve the quality of life for a terminally ill
       patient;
       3.) The item or service is necessary as a replacement due to an act occasioned by violence
       of nature without human interference, such as a tornado or flood; or
       4.) The item or service is necessary to prevent a higher level of care.



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                                                                                      MO HealthNet
                                                            Specialized Medical Equipment & Supplies
                                                                                           10-01-09


Supplies and Equipment clarification
The following items are some examples of equipment and supplies that have been purchased by
regional centers in the past. MO HealthNet staff reviewed the list of items and advised whether
MO HealthNet could cover any of the items. This information is being provided as examples of
how some equipment and supplies may be obtained through various MO HealthNet programs
and processes. Before using the waiver service, specialized medical equipment and supplies,
regional center staff should consider whether an item or supply might be covered by the MO
HealthNet DME program, Exception program, or Pharmacy program.



Items that may be covered by MO HealthNet as Pharmacy Services
Vitamins

Items that may be covered by MO HealthNet Durable Medical Equipment (DME) Program
Regardless of Person’s Age
  Bed Rails                               Side rail wedges
  Chem-Strips                             Augmentative Communication Devices
  Helmets                                 Wheeled commode
  Ostomy Flanges                          Roho Cushion
  Orthopedic Shoes (covered for           Heel protectors (covered for diabetics or if
  diabetics                               attached to a leg brace)
  or if attached to a leg brace)
  Shoe lifts (covered for diabetics or if Colostomy and ostomy bags and supplies
  attached to a leg brace)


Items that may be covered by Medicaid under DME for persons under age 21 and as Exception
Requests for persons over age 20. (Consider cost effectiveness.) It may require significant staff
time to get exception requests approved. Although there is no DMH cost for items covered as
exceptions, it may be cost effective to purchase items through the waiver as specialized medical
equipment or supplies.
  Catheters                                  Ted Hose
  G-Tubes                                    Toothettes & Spongeettes
  Feeding supplements                        Transfer bench
  Josbt Hose
  Leg bags & tubes
  Sharp containers (dispose of lancets etc.)
   for non-insulin dependent




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                                                                                  MO HealthNet
                                                        Specialized Medical Equipment & Supplies
                                                                                       10-01-09

Items that may be covered for children and youth under age 21 (HCY) through Medicaid DME
  Disposable diapers &/or briefs &/or     Intro Talker
  pullups
  Disposable bed liners, Chux             Leg bags & tubes
  Alpha Talker                            Raised toilet seat
  Feeding supplements                     Sharp containers (dispose of lancets etc) for
                                           non insulin dependent
  Bath rail, grab bar                     Shower chair
  Catheters                               Stand up lift (rare occasions)
  Communicator (if it replaces speech)    Toothettes & Spongettes
  Easy pivot machine                      Transfer bench
  Ensure                                  Tub lift
  G-tubes                                 Walker support railing prone stander
  Hand rails


Examples of items that cannot be covered by the Medicaid DME Program that may qualify as
waiver Specialized Medical Equipment & Supplies
 Adult disposable briefs                  Move-n-sit
 Reacher                                  Plate with suction
 Alert plus system for sight or hearing   Portable Wheelchair ramp
 impairments
 Computer to use with TTY                 Power Link
 Cup holder                               Right hand spoon
 Divided plate                            Scoop plate
 Door knob extenders                      Shoe horn
 Elastic shoe laces                       Shower caddy
 Electric door                            Special toothbrushes & heads
 Electric magnifier                       Stair lift
 Electric timer device                    Test strips for non-insulin dependent
 Environmental control unit life chair    Toilet arm rest
 Fan (signals for persons who have sight  TTY
 and hearing impairments)
 Gait Belt                                Van lift
 House alarm                              Vertical rail
 Lancets for non-insulin dependent        Wash mitt
 Molded tub bar                           Wheel chair lift




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